Incidence and Outcome of Operatively Treated Achilles Tendon Rupture in the Elderly

Background: Very little has been published about Achilles tendon rupture in the elderly. Optimal therapy is controversial with conservative treatment generally recommended. The purpose of our study was to find the incidence and outcome of operatively treated Achilles tendon ruptures in the elderly. Materials and Methods: We determined the incidence of a closed complete Achilles tendon rupture in a period from 1991 to 2000 in two centers caring for 572,929 people with 108,668 people over 60 years of age. Results: In a 10-year period there were 434 ruptures, all of which were treated operatively: 146 in an open fashion and 288 percutaneously. The average incidence was 7.6 ruptures per 100,000 people. The average age of patients was 38.7 years, with a male-to-female ratio of 16.7:1. There were 14 ruptures in 13 patients older than 60 years, with the incidence of 1.28 ruptures per 100,000 people. Seven of the ruptures were operated on in an open way under spinal anesthesia and seven percutaneously under local anesthesia. The average age of the patients was 67.9 years, with a male-to-female ratio of 1.6:1 and the mean ASA score 1.64. There were no major complications in either group. One patient in the percutaneous group had transient sural nerve injury and one patient in the open group had a superficial infection. All of the patients returned to their previous activities, four of them with some limitations. The average AOFAS score was 93.1 points. Conclusion: Achilles tendon rupture in the elderly is a rare injury. Operative treatment can yield a successful outcome. Level of Evidence: III, Retrospective Comparative Study